Insurance, without the headaches
How Insurance at Clarity Therapy Works
You’ve got enough stress,
OUR JOB IS TO TAKE SOME AWAY
All of our therapists are Out-of-Network providers. This means that we’re not in-network or credentialed with any insurance companies.
However, if your plan has out-of-network benefits, your insurance company typically will reimburse you directly after you’ve met your deductible.
Typically, when a client receives care from an out-of-network provider, they will need to pay the full cost of the services upfront. Afterward, they can submit a claim to their insurance company for reimbursement. The insurance company will review the claim, determine the eligible amount to be paid based on their out-of-network coverage policy, and then issue reimbursement directly to the client.
5 simple steps to make the process easy
Confirm your benefits
Learn how it works
Submit your claims
Keep us informed
1. Complete your paperwork on Simple Practice (required)
Before you begin therapy, you’ll receive an email from Simple Practice. The subject of the email will be “Client Portal” and will be sent from your therapist @simplepractice.com. Your client portal will have all of the intake paperwork that needs to be completed before your first session.
If you’re having trouble accessing Simple Practice, please reach out to [email protected] for assistance.
2. Look up and confirm your out-of-network benefits
Going to therapy means that you’re making an important investment in your emotional health and wellbeing.
Our therapy rates vary by therapist and the length of sessions. At Clarity, we think that cost shouldn’t get in the way of receiving quality psychotherapeutic services.
Are you unsure if you’re eligible for insurance reimbursement?
Dealing with insurance companies can be a confusing and frustrating experience. You can use the Insurance Benefits Lookup Tool to check your out-of-network benefits. This tool can provide an estimate of what you may expect to pay and be reimbursed for therapy. It’s important to keep in mind that this estimate is not a guarantee of reimbursement.*
*Remember to confirm the estimated reimbursement amount with your insurance company as they have the most up-to-date information about your benefits. Additionally, if you are going to have telehealth sessions, it is important to confirm you are eligible for telehealth services.
Questions to ask your insurance representative:
“Does my plan include out-of-network benefits for mental health care? Specifically, for outpatient psychotherapy?” “And, telehealth visits?”
“Do I have a deductible for out-of-network mental health services? If yes, what is the remaining amount I will have to pay before my health plan starts to reimburse me for fees that I pay out-of-pocket?”
“What is the maximum amount my plan will reimburse for mental health service code 90837 with a Psychotherapist?” If the rep does not provide a clear answer, ask: “What is the maximum allowed amount for mental health service code 90837 with a psychotherapist, and what percentage of the maximum allowed amount will my plan pay?” (This percentage of the maximum allowed amount is the amount you would receive as reimbursement.)
Superbill and/or Courtesy Claims submission eligibility: Once you confirm your plan provides out-of-network coverage our team will let you know if you are eligible for superbills and/or our courtesy claims submission program. *Please see the list below of plans that are not supported by our courtesy claims submission program. This list is subject to change.
3. Learn how TO GET REIMBURSED
What is a superbill?
A superbill is a detailed itemized statement or form used in medical billing. It is a document that your mental health provider gives to patients after a session, outlining the services rendered and the associated costs.
The primary purpose of a superbill is to facilitate the reimbursement process between patients and their insurance companies. It contains all the necessary information that insurers require to process claims and reimburse patients for covered medical expenses.
What information is included on a superbill?
Patient Information: Patient name, date of birth, contact details, insurance information, and any relevant patient identification.
Provider Information: Therapists name, practice address, contact details, and any sorrnecessary provider identification numbers.
Date(s) of Service: The date(s) on which the medical service was provided.
CPT (Current Procedural Terminology) Codes: These are standardized codes that represent medical procedures and services. Each service provided during the appointment is assigned a specific CPT code.
Diagnosis Code (ICD-10): Diagnosis codes that correspond to the patient’s medical condition. These codes explain why the services were performed.
Description of Services: A brief description of the medical services or procedures performed during the appointment.
Place of service (POS): The code that is related to in-person or virtual visit. 11 is the POS code for in-person (an appointment takes place with the client in the therapist’s office). 10 is the POS for telehealth visits.
Units: The quantity of each service provided. For instance, if a patient received two vaccinations, there would be two units listed for that specific service.
Fee or Charge: The cost associated with each service rendered, along with the total charges for the appointment.
What is COURTESY CLAIMS SUBMISSION?
Courtesy claims submission refers to the process by which a healthcare provider submits out-of-network insurance claims on behalf of their clients. When a client visits a provider that is out of their network, in some cases, the provider may still submit the insurance claim as a courtesy. This means that the provider sends the claim to the client’s insurance company for processing, even though they are not contracted with that insurance.
How Courtesy Claims submission works:
- Each session is paid in full at the time of service.
- Our billing team submits your claims within 2-4 weeks of the date of service
- Once you meet your deductible, you receive reimbursement directly from your insurance provider.*
**This process does not change once the deductible is met. Clarity does not accept any insurance payments.
It is important to note that not all insurance plans support courtesy claims submission, and the willingness to accept such claims can vary between insurers. At the time of registration, our team will determine whether or not a client’s insurance plan is eligible for courtesy claims submission. If we are unable to support a client’s plan, our team will provide you with a monthly superbill.
Please also note that we are unable to track your claims processing status and may not be able to support appeals for denied claims.
4. SUBMIT YOUR CLAIMS
If you are receiving superbills you will receive an email from Simple Practice on the 5th of every month for the month prior. This email will provide a secure link for you to download your superbill.
Submitting a superbill involves sending the document to your insurance company for reimbursement or keeping it for your records.
How to submit a superbill to your insurance:
Review: Double-check the accuracy of the information on the superbill, including service dates, service descriptions, codes, and costs.
Contact Your Insurance: If you’re planning to seek reimbursement from your insurance company, contact them to inquire about their specific submission process, required forms, and any additional documentation they may need.
Submit the Superbill: Depending on your insurance company’s requirements, you may need to mail, fax, upload electronically, or submit the superbill through an online portal. Some insurers might also require you to fill out a claim form along with the superbill.
Keep a Copy: Make sure to keep a copy of the submitted superbill, claim form (if applicable), and any other related documents for your records.
Follow Up: If you don’t receive reimbursement or any response from your insurance company within a reasonable timeframe, follow up with them to inquire about the status of your claim.
Remember that the specific process can vary based on your insurance company’s policies and the nature of the medical services. Always communicate directly with your insurance company to ensure you follow the correct procedure for submitting a superbill.
If you’re eligible for Courtesy Claims Submission
Once your benefits have been verified our team will enroll you. You can expect your claims to be submitted within 4 weeks of your session date.
Track the progress of your claim in your insurance provider’s portal. Depending on what you’ve set up with your insurance company, once you have met your deductible, you may receive your reimbursement by ACH deposit or check.
This usually takes between 2-4 weeks from date of submission. This will occur until your plan rolls over and your deductible resets. Depending on your plan, this usually happens in January or July, or when you start a new policy.
5. remember to keep us informed
If your insurance or credit card information changes or expires, please make sure to update your information by emailing [email protected] or calling 917-847-7556.
Unsupported insurance plans
Below is a list of plans that we are currently unable to support for courtesy claims submission. If your plan is on this list, and it provides out-of-network benefits, our team is happy to send you with a monthly superbill to submit directly to your insurance. Please note our team must verify each insurance plan before guaranteeing courtesy claims submission.
|Fidelis – Am Better
All Medicare/Medicaid plans
|Any EPO/HMO plans
|Beacon – Now Carelon Behavioral Health, Inc.
|Benefit Administrative systems
Partners Healthcare MA
|Compsych (Comcast Plans via BCBS)
PHCS Specific Services, Network PPO
Still have questions?
Check out our FAQ and insurance term glossary for more helpful information. If you have a question that you don’t see covered, don’t hesitate to reach out.